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Difficulty: HardPharmacological and Parenteral Therapies

A client with advanced cancer has a single-lumen peripherally inserted central catheter (PICC). A primary infusion of 0.9% sodium chloride is running at 50 mL/hr, and a continuous infusion of hydromorphone for severe, intractable pain is connected via a Y-site to the primary line. The nurse needs to administer a scheduled dose of intravenous vancomycin over 90 minutes. A drug reference indicates that vancomycin is physically incompatible with hydromorphone. Which of the following is the most appropriate nursing action?

  1. A
    Pause the hydromorphone, flush the central line, infuse the vancomycin over 90 minutes, and then resume the hydromorphone.
  2. Establish a separate peripheral intravenous catheter to administer the vancomycin infusion.Answer
  3. C
    Connect the vancomycin to a Y-site port higher on the primary tubing so it is diluted by the sodium chloride before mixing with the hydromorphone.
  4. D
    Suspend the hydromorphone temporarily, administer the vancomycin rapidly over 20 minutes to minimize pain interruption, and reconnect.

Answer

Establish a separate peripheral intravenous catheter to administer the vancomycin infusion.
When a client requires a continuous infusion of a critical, life-sustaining, or symptom-controlling medication (such as opioid analgesics for severe pain, or vasopressors) and a scheduled intermittent medication that is physically incompatible, the nurse must establish a separate intravenous access site. Pausing the hydromorphone for 90 minutes would result in a severe exacerbation of cancer pain. The two medications cannot be run in the same single-lumen line because they will precipitate when they meet in the common tubing.

Step-by-Step Solution

1
Identify the physical incompatibility between the ordered medications.
Vancomycin and hydromorphone are physically incompatible and cannot be mixed in the same intravenous line or lumen.
Mixing them will cause chemical precipitation, which can lead to catheter occlusion or a life-threatening embolism.
2
Evaluate the clinical significance of the continuous hydromorphone infusion.
The hydromorphone infusion is critical for managing the client's severe, intractable cancer pain.
Pausing the infusion for the 90-minute duration of the vancomycin dose would result in unacceptable breakthrough pain and potential withdrawal symptoms.
3
Determine the safest method of administration for both medications.
A new, separate peripheral IV line must be started.
This is the only way to allow both the critical continuous analgesia and the scheduled antibiotic to infuse simultaneously and safely without mixing.

Key Concept

Management of incompatible intravenous medications with critical continuous infusions
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Topics

Pharmacological and Parenteral Therapies

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